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NPI Code Detail

MEDICARE: HANEUL LEE M.ED

MEDICARE: HANEUL LEE M.ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1225867880
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANEUL LEE M.ED
Provider Business Mailing Address
First Line : 2122 KRATKY RD STE 100
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63114-1706
Country : US
Telephone Number : 314-825-4450
Fax Number : 844-519-7811
Provider Business Practice Location Address
First Line : 2122 KRATKY RD STE 100
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63114-1706
Country : US
Telephone Number : 314-825-4450
Fax Number : 844-519-7811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 07/31/2024

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